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1.Mention Determinants of Resistance Exercise and Discuss One of Them o Alignment of segments of the body during exercise o Stabilization of proximal or distal joints to prevent substitution o Intensity: the exercise load (level of resistance) o Volume: the total number of repetitions and sets in an exercise session multiplied by the resistance used o Exercise order: the sequence in which muscle groups are exercised during an exercise session o Frequency: the number of exercise sessions per day or per week o Rest interval: time allotted for recuperation between sets and sessions of exercise o Duration: total time frame of a resistance training program o Mode of exercise: type of muscle contraction, position of the patient, form (source) of resistance, arc of movement, or the primary energy system utilized o Velocity of exercise o Periodization: variation of intensity and volume during specific periods of resistance training o Integration of exercises into functional activities: use of resistance exercises that approximate or replicate functional demandsBenefits of Continuous Passive Movement (CPM) o Enhance nutrition and metabolic activity of articular cartilage o Stimulate tissue remodeling and regrowth of articular cartilage o Accelerate healing of articular cartilage, tendons, and ligaments 4.o Contracture: Restricted motion can range from mild muscle shortening to irreversible contractures adaptive shortening of the muscle tendon and other soft tissues surrounding joint that results in resistance to passive or active stretch and limitation of ROM.Define Relaxed Passive Movement & Explain Its Principles Definition: Relaxed Passive Movement is a movement performed accurately, rhythmically, and smoothly by the physiotherapist through the available range of motion while the patient's muscles are inactive and fully relaxed.Define Active Free ROM Exercise & Discuss Its Types Definition: Active Free ROM exercises involve voluntary movement by the patient through the full range of motion, against gravity or gravity eliminated and it's consist of simple everyday movements and gymnastics exercises. Contraindications for Active Assisted ROM Exercises o After myocardial infarction or coronary artery bypass surgery (only with careful monitoring).Define Active Assisted ROM Exercise & Explain Types of Assistance Definition: Active Assisted ROM exercises are movements where the patient voluntarily contracts muscles but cannot complete full range of motion without help.Define Stretching Exercise & Explain Terms Related to Mobility A. Definition : therapeutic maneuver designed to lengthen shortened soft tissue structures to increase ROM.o Passive flexibility: type of flexibility,referred to passive mobility , degree to a joint can be passively moved through available ROM , it is dependent on extensibility of muscles and connective tissues that cross and surround a joint.results from muscle hypertonicity (spasticity or rigidity) due to CNS lesions (e.g., stroke, spinal cord injury, traumatic brain injury,cerebral vascular accident), Or muscle guarding/spasms Or pain.longer a fibrotic contracture persists or greater normal tissue replacement with nonextensible adhesions and scar tissue or bone, the harder to restore optimal mobility and the more likely it is that contracture will become irreversible.Define CPM : Is a treatment modality , joint motion is provided by a machine, without causing active contraction of muscles,CPM is direct opposite of immobilization,It's a common post- surgical technique used to prevent unwanted effects of immobilization.Fibrous changes in connective tissue of muscle and periarticular structures can cause adherence of these tissues and development of a fibrotic contracture.Compare Different Types of CPM Parameter Free Linkage Anatomical Non-Anatomical Joint Stability Very Poor Good Fair ROM Control Very Poor Excellent Fair Total ROM Poor Excellent Good Multi-axis Motion Good Poor Fair Adjustable Excellent Poor Fair 21.Contraindications for Active ROM Exercise o Cardiopulmonary dysfunction (e.g., heart failure, angina, myocarditis, pericarditis).Explain Clinical Application of Continuous Passive Movement (CPM) o CPM is applied immediately after surgery, even with braces or bandages.Explain Indications of Active Assisted ROM Exercises o Muscle weakness preventing full independent movement.o Dynamic flexibility: type of flexibility, referred to active mobility, is degree to an active muscle contraction moves a body segment through available ROM of a joint.muscles remain in a constant state of contraction, giving rise to excessive resistance to passive stretch o Fibrotic Contracture and Irreversible Contracture: ?Mention Types of CPM & Discuss One of Them Types: o Free linkage CPM o Anatomical CPM o Non-anatomical CPM Anatomical CPM: Mimics natural joint motion, especially suitable for knees; provides excellent control of ROM and joint stability.o Fixation: Stabilize proximal and distal joints to isolate movement to the specific joint.o Traction: Thought to facilitate movement by reducing intra-articular friction.o Speed & Duration: Movements should be slow, rhythmic, and repeated at a suitable pace to promote relaxation.o Contracture Versus Contraction: The terms contracture and contraction (the process of tension developing in a muscle during shortening or lengthening ) are not synonymous.Define Fundamental Positions & Describe Standing Position o Definition: position we adopt for exercise or movement, it is the position, which altered from the five fundamental positions.Explain Procedures of Continuous Passive Movement o Set initial small ROM (e.g., 0-60?), gradually increase.Enumerate Indications of Relaxed Passive Movement o Cases of paralysis (complete bed rest).o Myostatic (myogenic) Contracture: ?2.3.5.6.7.8.9.10.??????1.12.13.15.16.17.18.19.20.22.23.24.25.

1. Define Relaxed Passive Movement & Explain Its Principles
   Definition:
   Relaxed Passive Movement is a movement performed accurately, rhythmically, and
   smoothly by the physiotherapist through the available range of motion while the
   patient’s muscles are inactive and fully relaxed. The joint is moved within the painless
   range and in the same direction as active movement.
   Principles:
   • Relaxation: Provide a comfortable position and support for both patient and
   therapist.
   • Fixation: Stabilize proximal and distal joints to isolate movement to the specific
   joint.
   • Support: Fully and comfortably support movable part maintain patient relaxation.
   • Traction: Thought to facilitate movement by reducing intra-articular friction.
   • ROM: Movement should be within painless limit to avoid muscle spasm.
   • Speed & Duration: Movements should be slow, rhythmic, and repeated at a
   suitable pace to promote relaxation.


2. Enumerate Indications of Relaxed Passive Movement
   • Cases of paralysis (complete bed rest).
   • Presence of inflammatory reaction.
   • Patients in coma.
   • To assist in muscle relaxation and reduce spasm.


3. Benefits of Continuous Passive Movement (CPM)
   • Enhance nutrition and metabolic activity of articular cartilage
   • Stimulate tissue remodeling and regrowth of articular cartilage
   • Accelerate healing of articular cartilage, tendons, and ligaments


4. Contraindications for Active ROM Exercise
   • Cardiopulmonary dysfunction (e.g., heart failure, angina, myocarditis,
   pericarditis).
   • Unhealed or unstable fracture.
   • Deep Venous Thrombosis (DVT) / Thrombophlebitis.
   • Severe muscle weakness.
   • Acute ligament or tendon tears.
   • Acute inflammation.
   • Dislocation.
   • Resting Heart Rate (RHR) above 120 bpm.
   • Neurological injuries affecting muscle control.
   • If the patient’s condition is life-threatening.


5. Explain General Goals of Relaxed Passive Movement
   • Improve sense of movement and position sense.
   • Maintain joint range of motion and prevent adhesions.
   • Preserve physiological muscle properties.
   • Maintain motor memory of movement.
   • Promote relaxation and reduce muscle spasm.


6. Explain Clinical Application of Continuous Passive Movement (CPM)
   • CPM is applied immediately after surgery, even with braces or bandages.
   • Start with small arc of motion (20–30 degrees), increasing 10–15 degrees per
   day.
   • Rate of motion is about 1 cycle per 45 seconds to 2 minutes.
   • Duration typically 60 minutes, three times a day, totaling 6–8 hours post-op.
   • Controls include power, range of motion adjustment, speed,
   acceleration/deceleration, and pause time at end ranges.
   • Devices are mainly for knee, but also for shoulder, elbow, wrist, ankle, TMJ.
   • Patient instruction and device fitting are essential for effective use.


7. Explain Indications of Active Assisted ROM Exercises
   • Muscle weakness preventing full independent movement.
   • After trauma, neurological disease, or chronic pain.
   • Post-cast removal or following tendon/muscle transplantation.
   • Muscle re-education.
   • Insufficient muscle strength or control to complete full ROM.


8. Contraindications for Active Assisted ROM Exercises
   • After myocardial infarction or coronary artery bypass surgery (only with careful
   monitoring).
   • Pathological end-feel limiting range of motion.
   • When movement would threaten healing or be life-threatening.
   • Increased pain or inflammation with movement.


9. Define Active Assisted ROM Exercise & Explain Types of Assistance
   Definition:
   Active Assisted ROM exercises are movements where the patient voluntarily contracts
   muscles but cannot complete full range of motion without help. Assistance may come
   from the therapist, the patient’s other limb, or mechanical devices.
   Types of Assistance:
   • Manual: Therapist or self-assisted using the unaffected limb.
   • Mechanical: Devices like pulleys, slings, or wheels.


10. Define Stretching Exercise & Explain Terms Related to Mobility
    A. Definition : therapeutic maneuver designed to lengthen shortened soft tissue
    structures to increase ROM.
    B. terms related to mobility.
    • Flexibility: ability to move joint smoothly and easily through unrestricted, pain-
    free ROM.
    • Dynamic flexibility: type of flexibility, referred to active mobility, is degree to
    an active muscle contraction moves a body segment through available ROM of a
    joint.
    • Passive flexibility: type of flexibility,referred to passive mobility , degree to a
    joint can be passively moved through available ROM , it is dependent on
    extensibility of muscles and connective tissues that cross and surround a joint.
    • Hypomobility: Hypomobility refers to decreased mobility or restricted motion.
    • Contracture: Restricted motion can range from mild muscle shortening to
    irreversible contractures
    adaptive shortening of the muscle tendon and other soft tissues surrounding
    joint that results in resistance to passive or active stretch and limitation of ROM.
    • Contracture Versus Contraction: The terms contracture and contraction (the
    process of tension developing in a muscle during shortening or lengthening ) are
    not synonymous.
    • Types of Contracture: pathological changes in different types of soft tissues
    involved.
    • Myostatic (myogenic) Contracture:
    ✓ adaptive shortening musculotendinous unit with reduced (ROM)
    ✓ no specific muscle pathology present.
    ✓ may be reduction in sarcomeres in series,no change in sarcomere length
    ✓ These contractures resolved in a relatively short time with stretching
    exercises.
    • Pseudomyostatic Contracture:
    ✓ results from muscle hypertonicity (spasticity or rigidity) due to CNS
    lesions (e.g., stroke, spinal cord injury, traumatic brain injury,cerebral
    vascular accident), Or muscle guarding/spasms Or pain.
    ✓ muscles remain in a constant state of contraction, giving rise to excessive
    resistance to passive stretch
    • Fibrotic Contracture and Irreversible Contracture:
    ✓ Fibrous changes in connective tissue of muscle and periarticular structures
    can cause adherence of these tissues and development of a fibrotic
    contracture.
    ✓ it is possible to stretch a fibrotic contracture and increase ROM
    ✓ it is often difficult to reestablish optimal tissue length.
    ✓ may result from prolonged immobilization in a shortened position or from
    tissue trauma followed by inflammation.
    ✓ longer a fibrotic contracture persists or greater normal tissue replacement
    with nonextensible adhesions and scar tissue or bone, the harder to restore
    optimal mobility and the more likely it is that contracture will become
    irreversible.
    • Mechanical Properties of Noncontractile Soft Tissue:
    ✓ permeates entire body
    ✓ organized into various types of connective tissue to support structures of the
    body.
    ✓ Tissue Connective tissue is composed of three types of fiber:
    ✓ collagen, elastin ( reticulin ) , non-fibrous ground substance


11. Define Fundamental Positions & Describe Standing Position
    • Definition: position we adopt for exercise or movement, it is the position, which altered
    from the five fundamental positions.


12. Standing 2. Sitting 3. Lying 4. Kneeling 5. Hanging.
    • Standing position:
    whole body is supported or aligned by the smaller base. So this position is most difficult to
    adopt for longer period,lot of coordinated muscle activity to maintain this posture.


13. Discuss Physiological Effects of Active Free Exercise
    • Prevents contractures, tightness, and pain from immobilization.
    • Improves circulation and proprioception.
    • Reduces joint rigidity.
    • Enhances respiratory capacity.
    • Mobilizes joints and soft tissues.
    • Enables functional movement and ambulation.


14. Contraindications of Relaxed Passive Movement
    • Unhealed fracture, recent fracture, at site of fracture.
    • At site of effusion or swelling.
    • Immediately following surgical procedure to joint, tendon, ligament.
    • Recent injuries.
    • Sever muscle weakness.
    • Acute inflammation or infection as osteomyelitis.
    • When a bony block limits joint motion.
    • Immediately after recent tear to ligaments, tendon.
    • Thrombosis ( DVT )


15. Mention Indications of Stretching
    • Post-traumatic stiffness.
    • Post-immobilization stiffness.
    • Restrictive mobility.
    • Congenital or acquired deformities.
    • Joint or soft tissue pathology causing stiffness.
    • Healed burn scars.
    • Adhesion formation.
    • Muscular spasm or spasticity.


16. Mention Types of CPM & Discuss One of Them
    Types:
    • Free linkage CPM
    • Anatomical CPM
    • Non-anatomical CPM
    Anatomical CPM:
    Mimics natural joint motion, especially suitable for knees; provides excellent control of
    ROM and joint stability.


17. Explain Procedures of Continuous Passive Movement
    • Set initial small ROM (e.g., 0–60°), gradually increase.
    • Adjust foot or limb assembly for comfort and positioning.
    • Set treatment speed (e.g., cycle time 4 minutes).
    • Instruct patient on operation and safety.
    • Clean device after use.
    • Monitor for swelling or complications.


18. Mention Goals of Active Assisted Exercise
    • Maintain joint and connective tissue mobility.
    • Minimize contracture formation.
    • Maintain muscle elasticity.
    • Assist circulation.
    • Enhance synovial fluid movement for cartilage nutrition.
    • Decrease pain.
    • Assist healing after injury or surgery.
    • Improve functional activities of daily living (ADLs).
    • Increase ROM.


19. Mention Contraindications of Stretching
    • Sharp pain during stretching.
    • Unhealed Scars.
    • Inflammation in the tight tissue.
    • Unhealed burns.
    • Infection over tight tissue.
    • Rheumatoid arthritis
    • Immediately after dislocation, sprain.
    • Malignant tumors.
    • Edema.
    • After joint arthroplasty.
    • Hemophilic joint.
    • Synovial effusion.
    • Hemarthrosis.
    • Recent fracture .


20. Define Active Free ROM Exercise & Discuss Its Types
    Definition:
    Active Free ROM exercises involve voluntary movement by the patient through the full
    range of motion, against gravity or gravity eliminated and it’s consist of simple
    everyday movements and gymnastics exercises.
    Types:
    • Localized: Target specific joints or muscles.
    Effects:
    ✓ Mobilization of joint
    ✓ Strengthening of muscle
    ✓ Pendulum exercise for the shoulder
    • General: Whole body or multiple joints involved (e.g., coordination, respiratory
    exercises).


21. Compare Different Types of CPM
    Parameter Free Linkage Anatomical Non-Anatomical
    Joint Stability Very Poor Good Fair
    ROM Control Very Poor Excellent Fair
    Total ROM Poor Excellent Good
    Multi-axis Motion Good Poor Fair
    Adjustable Excellent Poor Fair


22. Mention Precautions of Stretching
    • Protect recent fractures with stabilization.
    • Avoid forcing joint beyond normal ROM, may kead to joint instability.
    • Use caution with osteoporosis patients, due to risk of fracture
    • Avoid aggressive stretching after immobilization.
    • Progress stretching gradually.
    • Avoid pain lasting more than transient discomfort.
    • Avoid stretching swollen or edematous tissues.
    • Avoid overstretching weak muscles.
    • Maintain breathing during stretch, Holding breath may effect on blood pressure.


23. Discuss Characteristics of Active Free ROM Exercise
    • Performed by voluntary muscle contraction.
    • Can be against or gravity eliminated.
    • Movement can be simple or functional.
    • Must be within pain-free ROM.


24. Discuss Effects of CPM
    • Tissue stretching and collagen realignment.
    • Increases tensile strength.
    • Enhances synovial fluid circulation and nutrition.
    • Prevent joint effusion and wound edema
    • Decrease of immobilization.
    • Decrease post operation pain.
    • Improve circulation.
    • Prevent adhesion and contraction .


25. Define CPM :
    Is a treatment modality , joint motion is provided by a machine, without causing active
    contraction of muscles,CPM is direct opposite of immobilization,It’s a common post-
    surgical technique used to prevent unwanted effects of immobilization.


26. Mention Determinants of Resistance Exercise and Discuss One of Them
    • Alignment of segments of the body during exercise
    • Stabilization of proximal or distal joints to prevent substitution
    • Intensity: the exercise load (level of resistance)
    • Volume: the total number of repetitions and sets in an
    exercise session multiplied by the resistance used
    • Exercise order: the sequence in which muscle groups are
    exercised during an exercise session
    • Frequency: the number of exercise sessions per day or per
    week
    • Rest interval: time allotted for recuperation between sets
    and sessions of exercise
    • Duration: total time frame of a resistance training program
    • Mode of exercise: type of muscle contraction, position of
    the patient, form (source) of resistance, arc of movement,
    or the primary energy system utilized
    • Velocity of exercise
    • Periodization: variation of intensity and volume during
    specific periods of resistance training
    • Integration of exercises into functional activities: use of
    resistance exercises that approximate or replicate functional
    demands